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The following information was received via … The following information was received via facsimile:</br>A patient was prescribed 50 Gray to be delivered to a brain tumor bed via a GliaSite balloon inflated with 200 mCi of I-125 saline solution implanted for 66 hours. Upon removal of the balloon on March 7, 2014, it was discovered that the balloon had not inflated and no dose to the tumor bed had been delivered.</br>A three position stopcock was incorrectly positioned at the time of inflation and the I-125 saline solution was diverted to another syringe rather than to the balloon. All material is accounted for and is being held for DIS. The three position stopcock is not part of the vendor's kit.</br>Corrective Actions: In-service by the vendor scheduled, revision of policies and procedures to include verification of balloon via medical imaging post-infusion, and in-service to staff on new policies and procedures.</br>NYS Incident: #1054 </br>A Medical Event may indicate potential problems in a medical facility's use of radioactive materials. It does not necessarily result in harm to the patient.necessarily result in harm to the patient. +
04:00:00, 4 March 2014 +
49,931 +
16:03:00, 19 March 2014 +
04:00:00, 4 March 2014 +
The following information was received via … The following information was received via facsimile:</br>A patient was prescribed 50 Gray to be delivered to a brain tumor bed via a GliaSite balloon inflated with 200 mCi of I-125 saline solution implanted for 66 hours. Upon removal of the balloon on March 7, 2014, it was discovered that the balloon had not inflated and no dose to the tumor bed had been delivered.</br>A three position stopcock was incorrectly positioned at the time of inflation and the I-125 saline solution was diverted to another syringe rather than to the balloon. All material is accounted for and is being held for DIS. The three position stopcock is not part of the vendor's kit.</br>Corrective Actions: In-service by the vendor scheduled, revision of policies and procedures to include verification of balloon via medical imaging post-infusion, and in-service to staff on new policies and procedures.</br>NYS Incident: #1054 </br>A Medical Event may indicate potential problems in a medical facility's use of radioactive materials. It does not necessarily result in harm to the patient.necessarily result in harm to the patient. +
Has query"Has query" is a predefined property that represents meta information (in form of a <a rel="nofollow" class="external text" href="https://www.semantic-mediawiki.org/wiki/Subobject">subobject</a>) about individual queries and is provided by <a rel="nofollow" class="external text" href="https://www.semantic-mediawiki.org/wiki/Help:Special_properties">Semantic MediaWiki</a>.
00:00:00, 19 March 2014 +
CONFIDENTIAL +
Modification date"Modification date" is a predefined property that corresponds to the date of the last modification of a subject and is provided by <a rel="nofollow" class="external text" href="https://www.semantic-mediawiki.org/wiki/Help:Special_properties">Semantic MediaWiki</a>.
23:09:35, 24 November 2018 +
16:03:00, 19 March 2014 +
15.544 d (373.05 hours, 2.221 weeks, 0.511 months) +
04:00:00, 4 March 2014 +
URL"URL" is a <a href="/Special:Types/URL" title="Special:Types/URL">type</a> and predefined property provided by <a rel="nofollow" class="external text" href="https://www.semantic-mediawiki.org/wiki/Help:Special_properties">Semantic MediaWiki</a> to represent URI/URL values.